Staging

The staging of renal adenocarcinoma is carried out using the American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) system

T: primary tumour.

• TX: primary tumour cannot be assessed.
• T0: no evidence of primary tumour.
• T1: tumour <7 cm in greatest dimension, limited to the kidney.
  • T1a: tumour 4 cm or less in greatest dimension, limited to the kidney.
  • T1b: tumour >4 cm but not more than 7 cm in greatest dimension.
• T2: tumour >7 cm in greatest dimension, limited to the kidney.
  • T2a: tumour >7 cm in greatest dimension but equal or not more than 10 cm, limited to the kidney.
  • T2b: tumours >10 cm limited to the kidney.
• T3: tumour extends into major veins or perinephric tissues, but not into the ipsilateral adrenal gland and not beyond Gerota's fascia
  • T3a: tumour grossly extends into the renal vein or its segmental (muscle-containing) branches, or tumour invades the perirenal and/or renal sinus (peripelvic) fat but not beyond Gerota's fascia.
  • T3b: tumour grossly extends into the vena cava below the diaphragm.
  • T3c: tumour grossly extends into vena cava or its wall above the diaphragm or invades the wall of the vena cava.
• T4: tumour invades beyond Gerota's fascia (including contiguous extension into the ipsilateral adrenal gland).

N: regional lymph nodes.

• NX: regional lymph nodes cannot be assessed.
• N0: no regional lymph node metastasis.
• N1: regional lymph node metastasis.

M: distant metastasis.

• M0: no distant metastasis.
• M1: distant metastasis.

TNM information is combined to assign an overall anatomic stage of I-IV, which correlates with prognosis.

Reference:

• (1) Ljungberg B et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67(5):913-24.